Nurse 212: IV fluids
1 liter of fluid equals how many kilograms?
1 liter = 1 kilogram
Order: Isuprel (isoproterenol) 40 ml/hr IV Available: Isuprel 2mg in 500 mL D5W How many mcg/min is the patient receiving?
2.67 mcg/min
Order: 1 Gm Ancef in 50ml of D5W q8h. Equipment available 20 gtts/mL To infuse in 30 minutes the nurse should regulate the infusion rate at what drop rate (gtts/min)__________________________
33.3 = 33 gtts/min
What is the concentration of hypotonic solutions?
Hypotonic solutions have a concentration that is less than the concentration of plasma (less than 250 mOsm/L).
The doctor has ordered 250mL Lactate Ringer's to run for 5 hours for a 5 year old child. The micro drip factor is 60 (60gtt/mL). Compute the flowrate.
50 gtts/min
Isotonic fluids will lead to expansion of the ______ fluids.
extracellular
What are some hypertonic solutions?
Examples of hypertonic solutions include 5% Dextrose in 0.45% sodium chloride (D5 0.45%NS, D5½NS), 5% dextrose in lactated Ringers (D5LR, D5RL) 3% sodium chloride, 10% dextrose in water (D10W), D20W, D50W and colloids (albumin 25%, plasma protein fraction, dextran and hetastarch).
What are examples of hypotonic solutions?
Examples of hypotonic solutions include, one third normal saline (0.33% Sodium Chloride, 1/3 NS, 0.33%NS), half normal saline (0.45% Sodium Chloride, 0.45%NS, ½ NS) and 2.5% Dextrose in Water (D2.5W).
What are examples of isotonic fluids?
Examples of isotonic solutions include Dextrose 5% in Water (D5W), normal saline (0.9% Sodium Chloride, NS), and Ringer's Lactate (RL, LR).
True or False Solutions greater than 500 mOsm/L can be infused through a peripheral line.
False Use a central line to infuse IV fluids with a mOsm/L >500.
Is 5% Dextrose in 0.45% sodium chloride (D5 0.45%NS, D5½NS) isotonic, hypotonic, or hypertonic?
Hypertonic
Is Ringer's Lactate (RL, LR) isotonic, hypotonic, or hypertonic?
Isotonic
Is dextrose 5% in Water (D5W) isotonic, hypotonic, or hypertonic?
Isotonic
Is normal saline (0.9% Sodium Chloride, NS) isotonic, hypotonic, or hypertonic?
Isotonic
What do isotonic solutions treat?
Isotonic solutions can be used to treat dehydration and hypernatremia.
What concentration is isotonic fluid?
Isotonic solutions have a concentration of 250 to 375 mOsm/L.
Where does the isotonic solution remain?
Isotonic solutions remain in the intravascular space and there are no real shifts of fluids between the intracellular and extracellular spaces.
High osmolality causes what to move where from where?
The higher osmolality causes water to move out of the intracellular space into the intravascular space. This causes cells to shrink.
An 8-year-old child with gastroenteritis is prescribed to receive 500 mL of lactated Ringer's (LR) solution over the next 10 hours. The rate in milliliters per hour that a nurse should infuse the solution is _______ mL.
ANSWER: 50 The 50 mL per hour is obtained by dividing 10 hours into 500 mL of LR. ➧ Test-taking Tip: Use a known formula and check your answer, especially if it seems unusually large.
True or False When cells are exposed to a hypertonic solution they will swell as fluid moves into the intracellular space.
False When cells are exposed to a *hypotonic* solution they will swell as fluid moves into the intracellular space.
Your patient has been diagnosed with Pregnancy Induced Hypertension. The physician orders, "Magnesium Sulfate 8 g, IVPB in 100 ml D5W over 20 minutes." The label states, "Magnesium Sulfate 20% solution." The drop factor of the tubing is listed as 10 gtt/ml. 1. What volume of Magnesium Sulfate will you add to the D5W? 2. What is the drip rate (gtt/min) of the Magnesium Sulfate IVPB?
1.) 1. 40 ml 2.) 70 gtt/min
The order reads, "800 ml D5W to infuse over 8 hours." The drop factor is 15 gtt/ml. Calculate the drip rate (gtt/min).
25 gtt/min
Calculate the IV drip rate (gtt/min) for 400 ml of 0.9% NaCl over two hours. The drop factor is 20 gtt/ml.
67 gtt/min
A nurse who is initiating an intravenous infusion of lactated Ringer's (LR) for a client in shock recognizes that the purpose of LR for the client is to: 1. increase fluid volume and urinary output. 2. draw water from the cells into the blood vessels. 3. provide dextrose and nutrients to prevent cellular death. 4. replace electrolytes of sodium, potassium, calcium, and magnesium for cardiac stabilization.
ANSWER: 1 LR is an isotonic crystalloid solution containing multiple electrolytes in approximately the same concentration as plasma. It enters the cells from the blood, replacing fluids and increasing urinary output. A hypertonic solution draws fluid from the cells into the vascular compartment. LR alone does not contain dextrose. Formulations with dextrose are available. Magnesium is not a component of LR. ➧ Test-taking Tip: Apply knowledge of the components of LR and use the process of elimination. Eliminate options 3 and 4 because neither dextrose nor magnesium is a component of LR.
A 5-year-old client is receiving dextrose 5% in water and half-normal saline (D5 0.45 NaCl) solution at 100 mL/hr. Which findings during a nursing assessment suggest excessive parenteral fluid intake? SELECT ALL THAT APPLY. 1. Dyspnea 2. Gastric distention 3. Crackles 4. Lethargy 5. Temperature of 102°F (38.9°C) 6. Dry mucous membranes
ANSWER: 1, 3, 4 Dyspnea, crackles, and other signs of respiratory distress indicate fluid volume overload and occurs from fluid rapidly shifting between the intracellular and extracellular compartments. Lethargy and change in level of consciousness can occur from fluid shifting in brain cells. Gastric distention can occur from excessive oral fluid intake or infection. An elevated temperature and dry mucous membranes are signs of fluid volume deficit, not excess. ➧ Test-taking Tip: Eliminate options that pertain to oral fluid intake or fluid volume deficit.
A nurse is caring for a client recovering from surgery. Intravenous (IV) therapy is initiated to help maintain normal fluid balance. A physician orders 1,000 mL lactated Ringer's solution to be delivered over 8 hours. In order to infuse the IV fluids over 8 hours, the nurse should set the hourly infusion rate at ____ mL/hr.
ANSWER: 125 1,000 mL divided by 8 hours equals 125 mL/hour. ➧ Test-taking Tip: Read the question carefully to determine what is being asked. Remember that to determine the milliliters per hour, divide the volume to be infused by the number of hours over which it should be infused.
A nurse is hanging an intravenous (IV) solution of D5NS with 20 mEq of KCL. The nurse notices the label from the pharmacy is correct as indicated; however, the solution is D5W. Which actions should be taken by the nurse to safely administer the IV infusion? SELECT ALL THAT APPLY. 1. Check for one unique client identifier before administration 2. Consult the supervisor 3. Administer the IV solution 4. Call the pharmacist 5. First, initiate the new stat orders for another client 6. Know the organization's policy for medication administration
ANSWER: 2, 4, 6 Safe medication practices include knowing the organization's policy for medication administration and knowing what actions to take in the event of a potential error. This includes consulting the supervisor or calling the pharmacist. Although it is important to always check for two unique identifiers, that action will not prevent the medication error. The IV solution should not be administered since it is not the correct solution. Distractions, such as the assignment of another client with stat orders, may result in forgetting to clarify the IV solution. ➧Test-taking Tip: Note that the IV solution is incorrect; identify actions to prevent the error.
A nurse is caring for a client who has 0.9% NaCl infusing intravenously (IV). An order had been written the previous day to change the IV solutionto 0.9% NaCl with 10 mEq KCL. Which action should the nurse initiate first? 1. Notify the client's physician 2. Complete an incident report 3. Check the client's serum potassium level 4. Replace 0.9% NaCl with the ordered solution
ANSWER: 3 Because the order was written the previous day and not implemented, the nurse should first check the client's serum potassium level and then notify the physician. The nurse should determine if there are order changes before replacing the solution. The physician may change the amount of KCL in the IV solution based on the client's serum potassium level and other client data. An incident report should be completed by the nurse after caring for the client.
Osmolality is primarily determined by what?
Because sodium is the most common extracellular electrolyte, osmolality is primarily determined by the sodium level.
What isotonic solution is often used to manage dehydration? Why?
Dehydration is often managed by infusion of D5W. The reason for this is that the solution does not alter the interstitial and intracellular spaces, rather it replaces fluid volume in the intravascular space.
The patient is to receive a transfusion of 3 units of packed cells. Each unit contains 250 ml. You begin the first transfusion at 0800 and by 1400 the third unit should be infused. Special blood administration tubing set delivers 10 gtts/ml/min. How many mL per hour will the blood need to run?________________________________ What is the drop rate (gtts/min)?________________________________
How many mL per hour will the blood need to run?125ml/hr What is the drop rate (gtts/min)? 20.83 21 gtts/min
Heparin 25,000 Units in 500mL D5W at 50mL/hr has been infusing for 8 hours and the drug is discontinued. How many units of heparin was the patient receiving each hour?________________ How much total heparin was given?______________________________________
How many units of heparin was the patient receiving each hour? 2, 500 units/hour How much total heparin was given? 20,000 units
Is 10% dextrose in water (D10W), D20W, D50W and colloids (albumin 25%, plasma protein fraction, dextran and hetastarch) isotonic, hypertonic, or hypotonic?
Hypertonic
Is 5% dextrose in lactated Ringers (D5LR, D5RL) 3% sodium chloride isotonic, hypotonic, or hypertonic?
Hypertonic
What is often managed with hypotonic solutions?
Hypertonic dehydration, water replacement and diabetic ketoacidosis (after initial sodium chloride replacement) are often managed with hypotonic solutions. Precaution should be taken with patients who have hypotension as these fluids could further lower the blood pressure.
Hypertonic solutions are used for what?
Hypertonic solutions are used to replace electrolytes, to manage hypotonic dehydration (loss of fluid but a greater loss of sodium caused by vomiting, diarrhea, post operative loss, long term use of diuretics, burns), and short term treatment of shock. Caution should be taken because they can irritate blood vessels and may cause circulatory overload if too much fluid shifts from the interstitial space to the intravascular space. Hypertonic solutions should be given slowly.
Hypertonic solutions have what concentration?
Hypertonic solutions have a concentration that is higher than the concentration of plasma (375 mOsm/L or more).
Is 2.5% Dextrose in Water (D2.5W) isotonic, hypotonic, or hypertonic?
Hypotonic
Is half normal saline (0.45% Sodium Chloride, 0.45%NS, ½ NS) isotonic, hypotonic, or hypertonic?
Hypotonic
Is one third normal saline (0.33% Sodium Chloride, 1/3 NS, 0.33%NS) isotonic, hypotonic, or hypertonic?
Hypotonic
What is osmolality?
Osmolality describes the concentration in a one kilogram of water. Osmolality refers to fluids inside the body.
What is the osmolality of the intravascular?
The osmolality of the intravascular is 285 - 295 mOsm/kg.
Why do cells shrink when exposed to hypertonic solutions?
They shrink since water is pulled out of the cells.
Why do cells get bigger when they are exposed to hypotonic solutions?
They swell since fluid moves into the intracellular space.
True or False When cells are exposed to a hypertonic solution they will shrink because water is pulled out of the cells.
True
True or False When cells are exposed to an isotonic solution, they do not get larger or smaller.
True
What happens to fluid in the intravascular space when serum osmolality is reduced?
When the serum osmolality is reduced there is a shift of fluids from the intravascular space and into the intracellular and interstitial spaces. This causes cells to swell. Hypotonic solutions can deplete the intravascular space as fluid moves into the interstitial space.